A Summary of Transplantation Activity in Hungary.

The first kidney transplantation was performed in Hungary by András Németh in 1962. It was a living donor procedure. After many years of silence, organized cadaveric programs were established in Budapest (1973), Szeged (1979), Debrecen (1991), and Pécs (1993). The heart program was initiated by Professor Zoltán Szabó in 1992 and the liver transplant program by Professor Ferenc Perner in 1993. The pancreas transplantation program was started in Pécs in 1998 by Károly Kalmár-Nagy, followed another in Budapest by Robert Langer in 2004. The lung transplant program was started in cooperation with Vienna in 1996. This fruitful collaboration continues today, even though that the national Hungarian program was established by Ferenc Rényi-Vámos and Professor György Lang in 2015, as it is detailed in this special issue. As a framework, the Hungarian Society of Organ Transplantation was founded in 1997 to give a scientific background for the transplant professionals. The coordination and organ allocation from deceased donors is carried out in collaboration with Eurotransplant. Usually more than 200 potential cadaveric donors are reported yearly, and 168 actual donation after brain death (DBD) donors (17.17 pmp) were utilized in 2018. The multiorgan donor rate was 65.5% among all DBDs in 2018; 505 organs were donated for transplant purposes. To date, more than 10,000 organ transplantations have been performed. The living related kidney transplant program was established in all transplant centers, led by Budapest. In this paper the authors summarize the activity of the Hungarian transplant community and of the Society over the last few decades.

Acetylsalicylic acid resistance after renal transplantation.

BACKGROUND: Cardiovascular diseases are a leading cause of mortality after kidney transplantation. According to guidelines, acetylsalicylic acid (ASA) must be given as preventive antiplatelet therapy, but resistance to this drug is also well-known. PATIENTS AND METHODS: A total of 214 renal transplant patients were included in our study and took 100 mg of ASA q.d. Aggregometry was performed to determine resistance. Twenty-four variables were examined using logistic regression analysis as possible causes of resistance. RESULTS: ASA resistance was observed in 40.18% of the patients. Resistance reduced concomitant statin therapy and significantly increased simultaneous cyclosporine therapy. CONCLUSION: Our study assessed the post-transplant ASA resistance in a large population. Clarification of this matter is crutial, since one of the major preventive pharmacological therapies of cardiovascular mortality is not effective in a significant number of patients.

Clopidogrel resistance after renal transplantation.

BACKGROUND: Leading causes of mortality and morbidity after kidney transplantation are cardiovascular diseases. One of the fundamentals of their prevention is the inhibition of platelet aggregation. Resistance to anti-platelet agents is a well-established phenomenon; however, its causes are yet to be clarified. PATIENTS AND METHODS: Forty post-transplant patients, who received 75 mg clopidogrel q.d. as a prophylactic measure, were examined using optical aggregometry. Subsequently, logistic regression analysis was performed with 24 variables in order to expose possible causes of resistance. RESULTS: Sixty percent of patients (24) were resistant to clopidogrel therapy; effective thrombocyte inhibition could only be shown in 40% of them (16). Significant correspondence between resistance and variables could not be found. CONCLUSION: Clopidogrel resistance is expected to occur on a large scale in patients who underwent kidney transplant surgery. Thus, a key component of preventive therapy, which stresses the importance of discovering the cause of resistance so as to decrease mortality rates, is missing.

New chances for Hungarian transplantation--preface to the 12th Congress of the Hungarian Transplantation Society.

The year 2010 was a milestone in the history of transplantation in Hungary. Hungarian politicians became interested in solving the serious problems facing organ transplantation in our country. The State Secretary announced a program to (1) increase waiting lists, (2) raise donor numbers, (3) establish a lung transplant program, (4) promote education and increase the knowledge base regarding transplantation for the public and the medical profession, and finally, (5) to begin the negotiations for Hungary to join Eurotransplant. Joining Eurotransplant has been a priority of the transplant community. Finally, this year saw the Budapest Transplant Center perform 20% of their transplants from living kidney donors, up from 5% historically.

Subcutaneous hydatid cyst in the popliteal fossa at the site of a previous wasp sting.

We report an uncommon case of a primary Echinococcus cyst that developed in the subcutaneous tissue of the right popliteal fossa, at the spot of a previous wasp sting, suggesting the possibility of an unusual transmission of the eggs by insects. This unusual presentation was initially considered as a Baker cyst until parasytological results verified Echinococcus hydatidosus, the larval form of Echinococcus granulosus, as diagnosis. However, the most common path of Echinococcus granulosus infection is through contact with a definitive host or by ingestion of ova through contaminated water or food. Transmission by insects should also be reconsidered in endemic areas.

Alterations of glucocorticoid receptor expression during glucocorticoid hormone therapy in renal transplant patients.

Previous studies have demonstrated that glucocorticoid resistance develops in some patients during glucocorticoid therapy due to the down-regulation of glucocorticoid receptor (GCR) expression. A new flow cytometric method has been used for monitoring the intracellular GCR level in peripheral blood mononuclear cells (PBMCs). GCR expression by different lymphocyte subpopulations (bearing surface CD4+ CD8+ or CD19+) in steroid-treated (ST) and non-treated (NT) renal transplant patients was also compared. High, decreasing-dose steroid treatment caused a reduced GCR expression in 50% of the renal transplant patients. Long-lasting, low-dose steroid therapy caused a fall in GCR level in only 11% of patients. CD4+ T lymphocytes showed both the lowest GCR level and its alteration due to steroid therapy, while CD8+ T cells and CD19+ B lymphocytes expressed higher GCR levels and were more sensitive to steroid treatment. Detection of GCR expression in lymphocytes may provide useful information about the changes of glucocorticoid sensitivity during the therapy.